Antifungal Resistance in Patients with Candidemia: A Retrospective Cohort Study

Abstract Background: Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising, with limitations on the development of broader-spectrum antifungal agents worldwide. Our study aimed to identify the rate of antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with antifungal resistance and evaluate the association of antifungal-resistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality. Methods: A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidaemia from January 2006 to December 2017 were included. Results: A total of 196 BSIs were identified in 94 males (49.74%) and 95 females (50.26%). C. glabrata was the most commonly isolated Candida species, with 59 (30%), followed by C. albicans with 46 (23%). Susceptibility data were available for 122/189 patients, of whom 26/122 (21%) were resistant to one or more antifungals. C. parapsilosis with available sensitivity data were found in 30/122 isolates, of which 10/30 (33%) were resistant to fluconazole. Risk factors significantly associated with antifungal-resistant candidaemia included previous echinocandin exposure (odds ratio (OR) =1.38; 95% confidence interval (CI) (1.02-1.85); P= 0.006) and invasive ventilation (OR=1.3; 95% CI (1.08-1.57); P= 0.005). The median length of ICU stay was 29 days [range 12-49 days] in the antifungal-resistant group and 18 days [range 6.7-37.5 days] in the antifungal-sensitive group. The median length of hospital stay was 51 days [range 21-138 days] in the antifungal-resistant group and 35 days [range 17-77 days] in the antifungal-sensitive group. Thirty-day mortality was 15 (57.7%) and 54 (56.25%) among the antifungal-resistant and antifungal-sensitive groups, respectively (OR=1.01; 95% CI (0.84-1.21); P= 0.89).Conclusions: Our results indicate an increase in the rate of non-C. albicans candidaemia. The rise in C. parapsilosis resistance to fluconazole is alarming. Further studies are required to confirm this finding